Back pain

Introduction Back pain refers to the symptoms of pain in the back caused by injury or pregnancy in a certain body, obesity, poor static posture, and the like. Most of the low back pain is caused by muscle contracture, trauma or spinal deformity, but about one in every 10 patients is caused by systemic disease. Low back pain may occur anywhere on the back from the neck to the waist, and may be a small part or spread to a wide range. Low back pain is not only found in mental workers, but also widely among manual workers. It is the most common symptom in the clinic. Due to the difficulty of treatment, long course of treatment and easy recurrence, low back pain has become a dysentery that is difficult to treat in modern society, which seriously affects people's quality of life.

Cause

Classification of causes:

(1) Acute and chronic injury

1, acute injury: such as spinal fracture, ligament, muscle, joint capsule tear, acute disc herniation.

2, chronic damage: such as ligament inflammation, muscle strain, proliferation and degeneration of the spinal joints, spinal spondylolisthesis.

(two) inflammatory lesions

Inflammatory lesions are divided into bacterial inflammation and non-bacterial inflammation.

1, bacterial inflammation: can be divided into suppurative and specific infections such as spinal tuberculosis. Suppurative infections are more common in intervertebral space infections, epidural abscesses, and vertebral osteomyelitis.

2, non-bacterial inflammation: rheumatoid muscle fibrositis, rheumatoid arthritis, the third lumbar vertebrae transverse process syndrome, ankylosing spondylitis, can store joint compact osteitis.

(3) Degenerative changes of the spine

Such as intervertebral disc degeneration, small joint degeneration osteoarthritis, secondary spinal stenosis, senile osteoporosis, pseudo-sliding and spinal instability.

(four) abnormal bone development

Scoliosis, hemivertebra, narrow-necked porpoise, hunchback, lumbosacral or lumbar vertebrae, spina bifida and hook-like spinous processes, horizontal humerus, lower limbs, unequal length, flat feet.

(5) Poor posture

Long-term work at the desk or bent over, pregnancy, obesity caused by the abdomen.

(6) Tumor

Bone and soft tissue tumors, bone marrow or nerve tumors.

(7) Involved pain caused by visceral diseases

Gynecological pelvic disease, prostate disease, etc. can cause low back pain, kidney diseases such as calculus, renal ptosis, pyelonephritis and retroperitoneal diseases such as abscess, hematoma can cause low back pain, liver and heart disease can cause back pain.

(8) Mental factors

With the progress of society and the acceleration of the rhythm, such diseases gradually increase, such as chronic fatigue syndrome, psychosis spondylitis, neurasthenia, rickets, depression.

an examination

Related inspection

CT examination of the spine

First, simple low back pain

Simple low back pain refers to low back pain without lower limb pain or numbness. The main points of its differential diagnosis are as follows:

1. Age and gender

Age and gender are closely related to the cause of low back pain. Adolescents are prone to tuberculosis. Long-term sitting can lead to ligament inflammation or muscle fibroinitis. If adolescent males have a history of cold, they are prone to ankylosing spondylitis. Young women have lower back pain. Most of them are dense iliac bones due to pregnancy and strain. inflammation. Young and middle-aged household chores and work are more arduous, and the intervertebral discs, ligaments, and muscles have begun to degenerate. Therefore, lumbar disc herniation, myofasthesia, ligament inflammation, and spondylolisthesis occur. In the middle and old age, spine degenerative osteoarthritis is considered first. Ligament inflammation, if women should pay attention to osteoporosis and menopausal syndrome.

2, medical history

The back of the spine is sore on both sides of the spine. If you bend over or sit for a long time, it will be aggravated. If you rest in bed or after a little activity, you can alleviate muscle fiber inflammation. Pain in the back of the back, painless or relieved in the upright position, pain increased during flexion, waist weakness can not be bent for a long time to work, chest and lumbar segments are mostly supraspinous ligament inflammation, mainly lumbosacral segments For interspinous ligament inflammation. If the low back pain suddenly occurs after bending, and it is rapidly aggravated, and the waist is stiff and does not dare to move, it is mostly the incarceration of the lumbar facet joint synovial membrane. If the pain is mainly caused by the sacroiliac joint, sometimes accompanied by pain in the knee or myelopathy, cold or cloudy, the back pain is gradually developing upward, the spine is stiff, and may be accompanied by fatigue, low fever, loss of appetite, etc. Spondylitis. If the back pain gradually worsens, the nighttime pain will pay attention to the spinal tumor. If it is gradually aggravated, it will become a horn deformity, accompanied by low heat and weakness, night sweats, etc. may be vertebral tuberculosis, and some vertebral tuberculosis patients with low back pain There is a painless cold abscess. Lumbar disc herniation, nucleus pulposus removal after a few days to several weeks after the occurrence of severe deep pain in the waist, first consider the intervertebral space infection. Patients with fluorosis-prone areas or long-term drinking industrial pollution should be excluded from fluorosis caused by fluorosis.

3, check and check

The tenderness and the depth of tenderness are the primary methods for finding the lesion. Thumb tenderness is shallow tenderness, and snoring pain is deep tenderness. The superficial tenderness point is mostly supraspinous ligament inflammation in the spinous process, interspinous ligament inflammation in the interspinous process, muscle fibrositis in the muscles on both sides of the spinous process, and the third lumbar transverse process in the third lumbar vertebrae Syndrome, shallow tenderness lesions are mostly in superficial ligament muscles, so no positive findings on X-ray examination, deep tenderness should be examined in patients with no tenderness, and X-ray or CT examination should be performed on deep tenderness. If there is a history of traumatic fractures, the vertebral body should be considered for vertebral tumors. If the flattened vertebral body is fishtail and the bone density is generally reduced, osteoporosis should be considered. The spine has an angular deformity X-ray showing that the vertebral body has bone destruction, the intervertebral space is narrowed, or the paraspinal abscess is visible. It is characterized by vertebral tuberculosis, limited lumbar stiffness, and can cause joint pain, "4" test or The positive waterline of the oblique pull test shows the specific expression of the sacroiliac joint. The early joint space is blurred and widened, the edge is unclear and the bite is broken, and the gap is narrowed. The marginal bone is dense and even fusion can be ankylosing spondylitis. Performance, late X-ray showed that the spine showed a bamboo-like change, and there was osteoporosis. Spinal spondylolisthesis caused by a narrow stenosis can be seen in the lumbosacral region with a kyphosis X-ray lateral radiograph showing spine slippage, double oblique position It is shown that there is no exact relationship between the hyperplasia of the lumbar vertebrae and the low back pain. If the degeneration is obvious and the tenderness is deep, lumbar vertebrae stiffness can be considered for lumbar hyperplastic osteoarthritis. Reflex low back pain has no obvious pain, and lumbar motion is normal.

Second, low back pain accompanied by lower limb pain or numbness

Low back pain associated with numbness or pain in the lower extremities is mostly caused by compression of the thoracolumbar spinal cord or cauda equina or nerve roots and stems. The first lumbar vertebrae level above the spinal cord, patients may have intercostal neuralgia, high limb tension, femoral reflexes and lower extremity pathological signs positive, the second lumbar vertebrae oppression of the cauda equina or nerve roots, more occurrence of ponytail intermittent break, shares Nerve or sciatic nerve pain or numbness, corresponding femoral reflexes weakened or disappeared, no pathological signs.

Thoracic vertebrae compression is more common in thoracic tuberculosis tumors, intraspinal tumors, severe thoracic scoliosis, thoracic spinal stenosis, thoracic disc herniation and trauma. It should be noted that the thoracic and thoracic joints are roughly upper thoracic. The segment is different from the same number of vertebral bodies, the lower thoracic segment is about two different, the lumbar pith is 1~5 knots between the chest 11~waist 1~the waist 1~2, and the pith is located between the waist 1~the waist 1~2 The cause of traumatic thoracic cord compression is clear. There are often complete or incomplete lower extremity sacral lines showing fractures and displacement of the vertebral body. MR can clearly show that the spinal cord is compressed and completely broken. Patients with thoracic tuberculosis first consciously have back pain, or found that the thoracic spine is deformed into an angular deformity, necrotic intervertebral disc tissue, cheese-like substance, and dead bone can compress the spinal cord backwards. First, there is paralysis of the lower extremity. If not treated, it can be converted into flaccidity. The water line can be seen narrowing the intervertebral space, bone destruction, dead bone, paraspinal abscess, CT can clearly show the dead bone and abscess that is not easy to find in the spinal canal and X-ray. Thoracic spine tumors are more common in middle and old age, with metastatic tumors being the most common, followed by giant cell tumors and hemangioma. Sustained back pain, patients with pain at night or rest, gradually worsening, compression of nerve roots can cause severe intercostal neuralgia, easily misdiagnosed as abdominal organ diseases such as appendicitis, cholecystitis. Tumor compression of the spinal cord can cause paraplegia. X-ray can be expressed as osteolytic and osteogenesis. The main line of osteolytic destruction is S-line. The vertebral body is discoidally flattened, and the left and right can be widened. However, the intervertebral space is normal. CT examination is helpful for early detection of lesions. The vertebral hemangioma has a "fence-like" shadow on the X-ray film because the vertical and rough trabecular bone is clearly visible. The tumor in the spinal canal first stimulates the nerve root, causing radiation pain, and the upper thoracic segment is radiated to the chest. The lower thoracic segment radiates to the abdomen and is easily misdiagnosed as visceral disease. When the spinal cord is compressed, it first appears to be numb under the pressure plane, the lower limbs are weak, and then the sensation and movement that develops below the plane gradually loses. Spinal angiography can determine the diagnosis and localization. After CT, the size of the tumor and intramedullary or extramedullary can be observed. MR can show the shape, size and exact location of the tumor and the compression of the spinal cord, with or without trauma. Thoracic spinal stenosis and thoracic disc herniation are rare, and the symptoms are similar to those in the spinal canal. However, CT and MR examinations of the vertebral canal can be clearly diagnosed.

Differential diagnosis

Differential diagnosis of back pain:

1, back pain: back pain to see the extent of pain, if only the back of the pain, consider the thoracic dislocation, need to be reset. If you have a neck or only the inside of the scapula, consider neck and shoulder syndrome and loosen the muscle spasm.

2, the back has a vague numbness discomfort: the back has a vague numbness discomfort is considered to be caused by neuralgia. Pain is one of the common symptoms of neurology. This kind of pain refers to the pain that is felt without external stimuli, also known as spontaneous pain. There are many types of spontaneous pain, and the lesions can be divided into peripheral neuropathic pain and central nervous pain.

3, sleeping back soreness: sleeping back pain is caused by cervical nerve compression nerves.

4, the continuous pain of the back of the back: the continuous pain of the back of the back is mostly caused by the injury of the lower back, common in lumbar muscle strain, back muscle fasciitis, lumbar disc herniation.

5, right back pain: right back pain is likely to be a symptom of cholecystitis, cholecystitis is a bacterial infection or chemical stimulation (change of bile composition) caused by cholecystitis, a common disease of the gallbladder. In abdominal surgery, the incidence rate is second only to appendicitis. This disease is more common in middle-aged people aged 35-55 years. The incidence of females is more than that of males, especially in obese women with multiple pregnancies.

6, shoulder and back muscle pain: shoulder and back muscle pain may be caused by cervical spondylosis, may also be caused by low back muscle fasciitis or phlegm.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.